"Time course evaluation & treatment of post-TBI brain tumor with corresponding visual field loss" [Poster, American Academy of Optometry – October 2013]
This case report describes a patient who developed a brain tumor seven years after sustaining traumatic brain injuries from military service. The patient presented with visual field loss, headaches, and hormonal imbalances. Imaging revealed a pituitary tumor compressing the optic chiasm, consistent with the patient's bitemporal hemianopsia. The patient was started on medication to shrink the tumor and address mood and hormonal issues. Visual fields were tracked over a year of treatment, showing changes corresponding to tumor size. While the relationship between traumatic brain injury and later brain tumor is unclear, addressing the tumor helped manage overlapping symptoms from both conditions.
Concussions, TBI, Reading, Balance, Car-Sickness, Attention, Visual Fatigue Problems Vision Therapy 101 for the Primary Care Practitioner By Stan Appelbaum, OD
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
An overview of the update in optic neuritis and the utility of OCT in multiple sclerosis presented at the MS perceptorship in Dasman Institute in April 13 , 2017
Concussions, TBI, Reading, Balance, Car-Sickness, Attention, Visual Fatigue Problems Vision Therapy 101 for the Primary Care Practitioner By Stan Appelbaum, OD
Optic Neuritis and OCT in Multiple Sclerosis neurophq8
An overview of the update in optic neuritis and the utility of OCT in multiple sclerosis presented at the MS perceptorship in Dasman Institute in April 13 , 2017
ABSTRACT
care in Pediatric head injuries –Nursing Neuro surgery ICU
Anu Antony , Deepak Agrawal
Department of Neurosurgery, JPNA Trauma Centre, AIIMS ,New Delhi
Background: Nursing assessment of pediatric head injuries is difficult as GCS scoring system is not applicable to this age group. Also managing head injured children in the same ICU with adults is challenging
Objectives: To assess outcome of admitted pediatric head injury patients (<12yrs) as a surrogate marker for nursing care in the ICU.
Materials &methods: In this prospective study over 9months (Jan2011-Sept2011), the demographic profile ,surgical intervention ,mode of injury and outcome was evaluated for all children with head injury admitted in neurosurgery ICU at JPNA Trauma Center AIIMS.
Result: 104 children with head injury were admitted in the ICU during study period. There were 70males & 34 females. The mean age was 6.5yrs (range day1-12yrs) 51 children had severe head injury, 19 had moderate&34had minor head injury. 51(49%) children underwent surgical intervention. The overall mortality rate was 19.23%(n-20).Mortality rate was 33.3% (n-17) in severe head injuries,5.9% (n-2) in minor head injuries and 5.2%(n-1) in moderate head injury group.84 children were discharged .Of these 84.5%(n-71)had improvement in GCS,10.7%(n-9) had same GCS&4(4.7%) children deteriorated. The average hospital stay was 10 days (range2-94 days).2 patients were still hospitalized at the time of this study.
Conclusion: The mortality rates compare very favorably with international data. This study shows head inured children can be managed appropriately in neurosurgery ICU with nurses trained in neuro- nursing
Discussion of clinical approach to typical (demyelnating) and atypical optic neuritis (immune/inflammatory/infectious) optic neuritis with evidence-based review.
Target: Ophthalmologists/Neurologists
Clinico pathologic case conference 2019, NeurologyPramod Krishnan
This presentation was part of the annual Clinico pathologic case conference of the Bengaluru Neurological Society for the year 2019. The case was provided by the Department of Neurology and pathology, NIMHANS, Bengaluru and i was the discussant. The clinical, radiological and investigation aspects of the case are discussed in detail and the final diagnosis based on histopathology was revealed in the end.
Diagnosis of MS and related disorders in children - Cheryl HemingwayMS Trust
Aims:
Review the spectrum of ADS and the
IPMSSG criteria for diagnosis of MS
Through cases illustrate the key features
of ADS and the differential diagnoses
Discuss some of the current challenges
and new phenotypes
Improving vision function in the patient with Traumatic Brain InjuryDominick Maino
Presentation at the 9th World Conference of the International Brain Injury Association meeting in Edinburgh, Scotland
ABSTRACT
Objectives: Few reports in the literature note how optometric vision therapy (OVT) can improve the quality of life for those with traumatic brain injury
(TBI). This presentation discusses the significant improvements of signs and elimination of symptoms noted after a regimen of OVT that resulted in improved oculomotor skills, attention, reading and driving ability in a patient with TBI.
Case Report: PA, a university professor, is a 53 y/o WF with a history of traumatic brain injury due to a car accident. Her symptoms included falling asleep while reading, avoidance of reading, decreased attention, and major problems parking her car. The TOVA (Test of Variables Attention) showed an ADHD Score of -4.00 while the Visagraph revealed significant problems in span of recognition, fixation, reading rate/comprehension, efficiency and fluency. She was diagnosed with convergence insufficiency, oculomotor dysfunction (pursuits/saccades), and attention deficit. Optometric vision therapy sessions followed a standard format that included monocular, biocular, binocular and an integration/stabilization therapy phase. Computer aided OVT included the use of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the EyePort.
After 27, 45 min OVT sessions both the TOVA and Visagraph showed normal attention and oculomotor skills, convergence insufficiency resolved, reading ability improved and parking problems eliminated. All other symptoms were either improved or eliminated. PA currently successfully teaches at a major USA university.
Conclusions: Individuals with TBI often exhibit marked problems in oculomotor skills, binocular vision dysfunction, attention, and other visual abilities that affect their quality of life. Primary eye care providers, in general, do not diagnosis or manage the many vision function, functional vision and vision information processing disorders associated with TBI. Primary eye care providers can utilize this case as a starting point to help them do so in the future or to motivate them to refer to those who have experience and expertise in this area. This case demonstrates that with OVT both symptoms and signs that adversely affect an individual’s quality of life after traumatic brain injury can be improved.
ABSTRACT
care in Pediatric head injuries –Nursing Neuro surgery ICU
Anu Antony , Deepak Agrawal
Department of Neurosurgery, JPNA Trauma Centre, AIIMS ,New Delhi
Background: Nursing assessment of pediatric head injuries is difficult as GCS scoring system is not applicable to this age group. Also managing head injured children in the same ICU with adults is challenging
Objectives: To assess outcome of admitted pediatric head injury patients (<12yrs) as a surrogate marker for nursing care in the ICU.
Materials &methods: In this prospective study over 9months (Jan2011-Sept2011), the demographic profile ,surgical intervention ,mode of injury and outcome was evaluated for all children with head injury admitted in neurosurgery ICU at JPNA Trauma Center AIIMS.
Result: 104 children with head injury were admitted in the ICU during study period. There were 70males & 34 females. The mean age was 6.5yrs (range day1-12yrs) 51 children had severe head injury, 19 had moderate&34had minor head injury. 51(49%) children underwent surgical intervention. The overall mortality rate was 19.23%(n-20).Mortality rate was 33.3% (n-17) in severe head injuries,5.9% (n-2) in minor head injuries and 5.2%(n-1) in moderate head injury group.84 children were discharged .Of these 84.5%(n-71)had improvement in GCS,10.7%(n-9) had same GCS&4(4.7%) children deteriorated. The average hospital stay was 10 days (range2-94 days).2 patients were still hospitalized at the time of this study.
Conclusion: The mortality rates compare very favorably with international data. This study shows head inured children can be managed appropriately in neurosurgery ICU with nurses trained in neuro- nursing
Discussion of clinical approach to typical (demyelnating) and atypical optic neuritis (immune/inflammatory/infectious) optic neuritis with evidence-based review.
Target: Ophthalmologists/Neurologists
Clinico pathologic case conference 2019, NeurologyPramod Krishnan
This presentation was part of the annual Clinico pathologic case conference of the Bengaluru Neurological Society for the year 2019. The case was provided by the Department of Neurology and pathology, NIMHANS, Bengaluru and i was the discussant. The clinical, radiological and investigation aspects of the case are discussed in detail and the final diagnosis based on histopathology was revealed in the end.
Diagnosis of MS and related disorders in children - Cheryl HemingwayMS Trust
Aims:
Review the spectrum of ADS and the
IPMSSG criteria for diagnosis of MS
Through cases illustrate the key features
of ADS and the differential diagnoses
Discuss some of the current challenges
and new phenotypes
Improving vision function in the patient with Traumatic Brain InjuryDominick Maino
Presentation at the 9th World Conference of the International Brain Injury Association meeting in Edinburgh, Scotland
ABSTRACT
Objectives: Few reports in the literature note how optometric vision therapy (OVT) can improve the quality of life for those with traumatic brain injury
(TBI). This presentation discusses the significant improvements of signs and elimination of symptoms noted after a regimen of OVT that resulted in improved oculomotor skills, attention, reading and driving ability in a patient with TBI.
Case Report: PA, a university professor, is a 53 y/o WF with a history of traumatic brain injury due to a car accident. Her symptoms included falling asleep while reading, avoidance of reading, decreased attention, and major problems parking her car. The TOVA (Test of Variables Attention) showed an ADHD Score of -4.00 while the Visagraph revealed significant problems in span of recognition, fixation, reading rate/comprehension, efficiency and fluency. She was diagnosed with convergence insufficiency, oculomotor dysfunction (pursuits/saccades), and attention deficit. Optometric vision therapy sessions followed a standard format that included monocular, biocular, binocular and an integration/stabilization therapy phase. Computer aided OVT included the use of Vision Builder, CAVTs VIPS, and Home Therapy Solutions HTS and the EyePort.
After 27, 45 min OVT sessions both the TOVA and Visagraph showed normal attention and oculomotor skills, convergence insufficiency resolved, reading ability improved and parking problems eliminated. All other symptoms were either improved or eliminated. PA currently successfully teaches at a major USA university.
Conclusions: Individuals with TBI often exhibit marked problems in oculomotor skills, binocular vision dysfunction, attention, and other visual abilities that affect their quality of life. Primary eye care providers, in general, do not diagnosis or manage the many vision function, functional vision and vision information processing disorders associated with TBI. Primary eye care providers can utilize this case as a starting point to help them do so in the future or to motivate them to refer to those who have experience and expertise in this area. This case demonstrates that with OVT both symptoms and signs that adversely affect an individual’s quality of life after traumatic brain injury can be improved.
Similar to "Time course evaluation & treatment of post-TBI brain tumor with corresponding visual field loss" [Poster, American Academy of Optometry – October 2013]
references:
Phases and Phenotypes of Multiple Sclerosis By Orhun H. Kantarci, MD.
Diagnosis of Multiple Sclerosis By Jiwon Oh, MD, PhD, FRCPC
Nature Reviews | Disease Primers
Multiple sclerosis Massimo Filippi1,2*, Amit Bar- Or3, Fredrik Piehl4,5,6, Paolo Preziosa1,2, Alessandra Solari7, Sandra Vukusic8 and Maria A. Rocca1,2
A guideline for discontinuing antiepileptic drugs in seizure-free patients – ...Dr. Rafael Higashi
Aula apresentada por Dr. Rafael Higashi, médico neurologista sobre quando retirar droga antiepilética. A guideline for discontinuing antiepileptic drugs in seizure-free patients – Summary Statement
Leigh Syndrome is a fatal mitochondrial disease with variable ophthalmologic manifestations. Ptosis can be the initial sign in patients with this rare inherited neurometabolic disorder. Misdiagnosis of conditions including juvenile myasthenia gravis and congenital ptosis delay proper identification and palliative care. We present a noteworthy case of a 16-month-old girl with acquired progressive bilateral ptosis who was diagnosed with Leigh Syndrome after further work up suggested by our examination.
An acute medical condition.
Common in UK critical care patients.
Serious adverse outcomes.
Bedside diagnosis.
Maybe the first sign of a new infection.
Pathological, not psychological.
you will learn about brain tumor, types of brain tumor, grading of brain tumor, risk factors for brain tumor, diagnosis for brain tumor, treatment for brain tumor, supportive care and rehabilitation for patients with brain tumor.
A neuromuscular disorder that leads to weakness of skeletal muscles.
Symptoms
Causes
Prevention
Complications
Common tests & procedures
Neurological examination:
Repetitive nerve stimulation test:
Antibody test:
Pulmonary function tests (PFTs): To check any breathing difficulty.
CT scan: To rule out a presence of tumor in thymus.
Magnetic resonance imaging (MRI): MRI of the chest is performed to rule out a presence of tumor in thymus.
Edrophonium (Tensilon) test:
Medication
Procedures
Nutrition
Similar to "Time course evaluation & treatment of post-TBI brain tumor with corresponding visual field loss" [Poster, American Academy of Optometry – October 2013] (20)
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Basavarajeeyam is an important text for ayurvedic physician belonging to andhra pradehs. It is a popular compendium in various parts of our country as well as in andhra pradesh. The content of the text was presented in sanskrit and telugu language (Bilingual). One of the most famous book in ayurvedic pharmaceutics and therapeutics. This book contains 25 chapters called as prakaranas. Many rasaoushadis were explained, pioneer of dhatu druti, nadi pareeksha, mutra pareeksha etc. Belongs to the period of 15-16 century. New diseases like upadamsha, phiranga rogas are explained.
The Gram stain is a fundamental technique in microbiology used to classify bacteria based on their cell wall structure. It provides a quick and simple method to distinguish between Gram-positive and Gram-negative bacteria, which have different susceptibilities to antibiotics
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These lecture slides, by Dr Sidra Arshad, offer a quick overview of the physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar lead (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
6. Describe the flow of current around the heart during the cardiac cycle
7. Discuss the placement and polarity of the leads of electrocardiograph
8. Describe the normal electrocardiograms recorded from the limb leads and explain the physiological basis of the different records that are obtained
9. Define mean electrical vector (axis) of the heart and give the normal range
10. Define the mean QRS vector
11. Describe the axes of leads (hexagonal reference system)
12. Comprehend the vectorial analysis of the normal ECG
13. Determine the mean electrical axis of the ventricular QRS and appreciate the mean axis deviation
14. Explain the concepts of current of injury, J point, and their significance
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. Chapter 3, Cardiology Explained, https://www.ncbi.nlm.nih.gov/books/NBK2214/
7. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
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Adv. biopharm. APPLICATION OF PHARMACOKINETICS : TARGETED DRUG DELIVERY SYSTEMSAkankshaAshtankar
MIP 201T & MPH 202T
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Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
CDSCO and Phamacovigilance {Regulatory body in India}NEHA GUPTA
The Central Drugs Standard Control Organization (CDSCO) is India's national regulatory body for pharmaceuticals and medical devices. Operating under the Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, the CDSCO is responsible for approving new drugs, conducting clinical trials, setting standards for drugs, controlling the quality of imported drugs, and coordinating the activities of State Drug Control Organizations by providing expert advice.
Pharmacovigilance, on the other hand, is the science and activities related to the detection, assessment, understanding, and prevention of adverse effects or any other drug-related problems. The primary aim of pharmacovigilance is to ensure the safety and efficacy of medicines, thereby protecting public health.
In India, pharmacovigilance activities are monitored by the Pharmacovigilance Programme of India (PvPI), which works closely with CDSCO to collect, analyze, and act upon data regarding adverse drug reactions (ADRs). Together, they play a critical role in ensuring that the benefits of drugs outweigh their risks, maintaining high standards of patient safety, and promoting the rational use of medicines.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pharynx and Clinical Correlations BY Dr.Rabia Inam Gandapore.pptx
"Time course evaluation & treatment of post-TBI brain tumor with corresponding visual field loss" [Poster, American Academy of Optometry – October 2013]
1. Time Course Evaluation & Treatment of Post-TBI
Brain Tumor with Corresponding Visual Field Loss
Maggie Jan, O.D.
Southern California College of Optometry at Marshall B. Ketchum University
VA Long Beach – Traumatic Brain Injury & Low Vision Rehabilitation Residency
Background
In recent research, traumatic brain injury (TBI) has been theorized as a possible
risk factor contributing to the development of brain tumors.1
In this case, a patient
with no previous history of brain tumors and no family predisposition for tumors
experiences a TBI. Seven years after sustaining IED blast-related military brain
injuries, the patient presents with symptoms consistent with a cranial neoplasm.
This study tracks the patient’s symptoms and visual field defect juxtaposed with
corresponding MRI images identified during the time course of tumor treatment.
Treatment & Management
• Medical team starts the patient on Parlodel® (bromocriptine) drug therapy
aimed at reducing the prolactin-secreting tumor size.
• If tumor fails to respond to drug therapy, invasive surgical pituitary tumor
resection remains an option but will require hormone replacement therapy.
• Testosterone therapy for decreased libido, weight gain, gynecomastia.
• Initiated mental care, psychiatry for depression and anger. Mood-enhancing
drug Wellbutrin® (bupropion HCl) and trazadone prescribed for insomnia and
mood changes.
• The visual fields are taken concurrently as tumor treatment is initiated. During
the time course of the patient’s treatment, a series of four 24-2 Humphery
threshold visual fields are taken over one year (Figure 1b). Challenges
acquiring visual fields from TBI patients exist – decreased visual attention,
PTSD and claustrophobia make it difficult to test.
• No prescription needed for distance vision. Sun wear with polarization
prescribed for protection against glare and symptomatic photophobia
secondary to TBI. Rx reading glasses for accommodative dysfunction.
References
1. McKinney, P A. “Brain Tumours: Incidence, Survival, and Aetiology.” Journal of
Neurology, Neurosurgery & Psychiatry. 75, 2004.
2. Mumenthaler, Marco, and Heinrich Mattle. “Visual Field Defects.” Fundamentals of
Neurology: An Illustrated Guide. Stuttgart: Thieme, 2006.
3. Kaufman, David M. “Visual Field Loss.” Clinical Neurology for Psychiatrists.
Philadelphia: Saunders/Elsevier, 2007.
4. Silverstone B, Lang MA, Rosenthal BP, Faye EE, editors. “Signs and Symptoms
of Chiasmal Lesions.” The Lighthouse Handbook on Vision Impairment and Vision
Rehabilitation. Vol. 2. New York: Oxford University Press. p 188-190.
5. Center for Disease Control and Prevention (CDC). National Center for Injury
Prevention and Control. Report to Congress on traumatic brain injury in the United
States. Atlanta (GA): Centers for Disease Control and Prevention. 1999, Dec.
6. Center for Disease Control and Prevention (CDC). National Center for Injury
Prevention and Control. Report to Congress on Traumatic Brain Injury in the United
States: Understanding the Public Health Problem among Current and Former Military
Personnel. Atlanta (GA): Centers for Disease Control and Prevention. 2013, Aug.
7. Elder, Gregory A, and Adrian Cristian. “Blast-related Mild Traumatic Brain Injury:
Mechanisms of Injury and Impact on Clinical Care.” Mount Sinai Journal of Medicine:
a Journal of Translational and Personalized Medicine. 76(2), 2009: 111-118.
Conclusions
• Addition of visual efficiency training or vision rehabilitation could be potentially
valuable in the future for helping the patient compensate for field loss.
• Growths + minute changes to mass/volume in confined space of sella turcica
can affect integrity of surrounding structures such as optic nerve, visual
function, and hormone secretions.
• Tracking changes to visual field not only helps radiologists gauge potential
treatment efficacy but serves dual purpose of helping the patient visualize
health status while continuing to undergo the remaining time course of
scheduled treatment with slow recovery.
• Patient’s brain tumor development following acquisition of TBI could be
coincidental. Although neuronal disruption and inflammation processes has
been hypothesized as a possible risk factor in epidemiological studies1, no
link is proven currently. Further research into patients that have both TBIs
and tumors to see if tumors do develop over time. The study must control for
and rule out genetic predisposition and subjects with existing tumors.
• 10% to 20% of veterans returning from Iraq and Afghanistan operations are
estimated to have suffered a traumatic brain injury.7
In addition, according to
CDC statistics the incidence of TBIs in current and former military personnel
has tripled in the six years between 2005 and 20116. High incidence and
quantifiable impact on quality of life necessitates the need to manage and
treat patients with TBI.
Case Report
Patient History
• 37-year-old Caucasian male, active duty military soldier complaining of visual
changes, difficulty with peripheral vision, difficulty seeing objects or people
who “suddenly appear” to his right or left.
• Vision loss is accompanied with symptoms of severe headaches worse in
the morning, poor balance and dizziness, decreased attention, personality
changes such as increased irritability and anger, problems with memory and
word retrieval, insomnia, weight gain, and gynecomastia.
• Med Hx: TBI secondary to fall with loss of consciousness from explosions
accompanied with impact in Iraq 7 years ago. Frontal lobe contusion with
encephalomalacia. MRIs taken at the time of the acquired brain injury revealed
no cranial lesions or masses. No family history of tumors.
• Ocular Hx: Unremarkable
• Medications: None
Exam Findings
• Ocular findings are unremarkable, with exception of mild decrease in
accommodative amplitudes, photophobia, and abnormal confrontation visual
field with findings of neglect in the superior temporal and inferior temporal fields
of both eyes.
• Baseline Humphery Threshold Visual Field 24-2 Sita Fast: temporal visual field
loss detected OD & OS (Figure 1a). Field loss is repeatable and displays pattern
of bitemporal hemaniopsia.
• Lab studies: Blood serum analysis reveals high levels of ACTH, elevated
prolactin, low levels of testosterone.
• Radiology studies: MRI imaging reveals a mass in the right side of the pituitary
gland measuring approximately 7x11x11mm which invades the sphenoid sinus
(Figure 2).
Differential Diagnosis & Discussion
• Differential Diagnoses (DDx) for Visual field loss: Pituitary adenoma (primary
DDx), mid chiasm neoplasm, craniopharyngiomas, meningiomas, anterior
carotid artery aneurysm.2
• Cranial neoplasm located in the pituitary determined to be the cause of patient’s
bitemporal visual loss, hyperprolactinemia, and hypogonadism.4
• Visual Field Loss & Visual PathwayAnalysis: Nerve fibers originating in the nasal
retina of each eye converge at the optic chiasm before crossing over to opposite
sides of the brain for higher level processing.2
Thus a compression of the optic
chiasm affects the visual impulse from both nasal retina which corresponds to
loss of temporal visual field in both eyes.3
• Symptoms of a moderate TBI could impact speech, sensory, vision and cognitive
symptoms5. Patient’s symptoms of: headaches, vertigo, trouble with memory,
attention, concentration deficits, irritability related to acquired brain injury.6
Of
these TBI-related symptoms some may closely resemble characteristics of a
brain tumor.
• Visual symptoms most commonly experienced by patients with TBI include:
accommodative dysfunction, noncompensating vergences, large phorias or
tropias, and photophobia.
• In this case symptoms of headaches, inattention, and irritability overlap in both
conditions; fortuitously, addressing these common symptoms via treatment of
the brain tumor will not exacerbate the underlying TBI.
• The patient’s TBI is categorized as “moderate” due to loss of consciousness
greater than half an hour but less than six hours, without open intracranial
wound5. Even with identification and diagnosis of the traumatic brain injury,
there exists no method of reversal for physical damage resulting from brain
injury. Current TBI care is centered around providing treatment of symptoms
and functional rehabilitation rather elimination of the condition.
Figure
2:
T1
Post-‐Gadolinium
MRI
Images
AXIAL
CORONAL
Acknowledgements to Major Jennifer Stoecklin Stowe, O.D.